Occasionally other tests are necessary to determine the cause of the heart failure. These tests may include Cardiac catheterization to determine the severity of any valvular disease or coronary artery disease, nuclear imaging, computerized tomography (CT) scan, or magnetic resonance imaging.
Clinical classification
Cardiologists classify the importance of a patient’s congestive heart failure on the basis of symptoms and cause. For symptoms the New York Heart Association (NYHA) classification is used:
- Class 1: ordinary physical activity does not cause symptoms
- Class 2: comfortable at rest, ordinary exercise causes symptoms
- Class3: comfortable at rest but marked limitation of physical activity due to symptoms
- Class 4: symptoms of heart failure even at rest
Treatment
Several treatment goals exist for the CHF patient. First, any underlying event that precipitated the heart failure condition should be treated. If an underlying condition is untreatable, then CHF therapy focuses on the alleviation of symptoms, reduction of further heart failure progression, and improvement in heart pumping efficiency. Treatment of CHF may entail hospitalization, initiation or adjustment of medications, surgery, and lifestyle modification. Appropriate CHF management demands the attention of a qualified health care professional.
Multiple medications are often required in the treatment of CHF. When taken consistently and exactly as prescribed, a well-tolerated regimen is highly effective at both alleviating symptoms and prolonging life. The mainstays of medical therapy include:
- Angiotensin Converting Enzyme (ACE) inhibitors (e.g., captopril, lisinopril, ramipril, etc).
- Angiotensin Receptor Blockers (ATB)that work in a fashion similar to ACE inhibitors
- Vasodilators, such as hydralazine, which dilate the blood vessels and reduce the heart's workload.
- Beta blockers (e.g., carvedilol, bisoprolol, metoprolol, atenolol), which reduce arrhythmias and improve the left ventricle's mechanical efficiency.
- Inotropes (e.g., digoxin), which increases the strength of cardiac contractions and reduces symptoms.
- Diuretics (e.g., lasix, aldactone, metolazone, torsemide, hydrochlorthiazide, indapamide), which eliminate water and sodium through the kidneys and reduce edema and shortness of breath.
- Aldosterone receptor blockers.
- Nitrates (such as nitroglycerine and isosorbide).
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